Food Insecurity Is Associated With Lower Diet Quality Among Hispanic/Latinos at High Risk for Type 2 Diabetes Mellitus

Background: Food insecurity has been associated with poor diet quality and increased diet-related chronic disease risk. Among racially and ethnically minoritized populations in the U.S., Hispanic/Latinos experience food insecurity twice as often, have overall lower diet quality, and are more likely to be diagnosed with type 2 diabetes mellitus (T2DM) compared with individuals identifying as non-Hispanic White. Understanding the direction, magnitude, and clinical significance of the association between food insecurity and diet quality will aid in designing culturally-responsive food-based nutrition interventions to improve diet quality, food security, and diabetes management for this population.Objective: To examine the association between diet quality and food insecurity, and the modifying effect of obesity on this association, among Hispanic/Latinos at high risk of, or with, T2DM. Methods: El Banco por Salud is a biobank comprised of predominantly self-reported Hispanic/Latino adults. Eighty-six individuals completed the U.S. Household Food Security Survey (18-item questionnaire) and at least one 24-hour dietary recall. Dietary quality was assessed using Healthy Eating Index (HEI-2015) scores. Linear regression models were used to examine the association between household food insecurity status and HEI-2015 scores. Models were adjusted for sociodemographic and health covariates. Results: Of the 86 participants, 76.7% were female and 44.2% had T2DM. Mean (SD) age and BMI were 47.3 years (13.0) and 33.1 kg/m2 (7.4), respectively. Average HEI-2015 score was 55.7 (14.1) (out of 100). In fully adjusted models, participants from households with food insecurity had significantly lower diet quality compared to participants from food secure households (Coefficient: -7.57, CI: -13.17, -1.97, p=0.009). Individuals from a food insecure household who had a BMI ≥30 experienced a substantially lower diet quality score compared with food secure individuals with a BMI<30 (Coefficient: -12.22, CI: -19.46, -4.99, p-interaction: 0.001). Conclusions: Food insecurity was associated with lower overall diet quality among Hispanic/Latino biobank participants at high risk of, or with, T2DM. Future studies should include food-based nutrition interventions to collectively address diet quality, food insecurity, and T2DM management for this population

Effect of weight change on the association between overall and source of carbohydrate intake and risk of metabolic syndrome: Tehran lipid and glucose study

Abstract Background In this prospective cohort study, we aimed to evaluate the association between dietary carbohydrates, whole grains, refined grains, and simple sugar with the risk of metabolic syndrome (MetS) and assess the effect of weight change on these associations. Methods This study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS). We included 1915 healthy participants with complete demographic, anthropometric and dietary measurements, among whom 591 developed MetS during 8.9 years of follow-up. Intake of dietary carbohydrates, whole grains, refined grains, and simple sugar was assessed with a validated semi-quantitative food frequency questionnaire. Multivariable adjusted Cox regression was used to estimate hazard ratios (HRs) for MetS events across tertiles of dietary variables. Using joint classification, the effect of weight change on the association between dietary variables and risk of MetS was assessed by Cox regression. Results Carbohydrate intake was not associated with the risk of MetS in multivariable-adjusted models. Whole grains intake was inversely associated with the risk of MetS (HR: 0.78, CI: 0.63–0.98), while this association disappeared after adjustment for weight change. The risk of MetS increased by 11% (1.11, 1.09–1.14) for each 3% energy increment from simple sugar, and by 5% (1.05, 1.03–1.08) for each 1 serving/day increment in refined grains. Consumption of refined grains increased the risk of MetS; an effect modification of this association was found by weight change. Among subjects with weight loss, intake of refined grains < median intake decreased the risk of MetS (0.59, 0.41–0.87). However, consumption of refined grains ≥ median intake increased the risk of MetS in individuals with weight gain (1.47, 1.08–2.01). Simple sugar was positively associated with an increased risk of MetS, after adjustment for weight change (3.00, 2.37–3.82). In joint classification, intake of simple sugar greater than median intake increased the risk of MetS, independent of weight change. Conclusion Our findings suggest an effect modification by weight change on the association between carbohydrates, and refined grains intake and the risk of MetS. Weight loss along with lower consumption of carbohydrates, and refined grains reduced the risk of MetS. However, simple sugar intake, regardless of weight change, was associated with an increased risk of MetS

Tools to Measure Health Literacy among Adult Hispanic Populations with Type 2 Diabetes Mellitus: A Review of the Literature

Health literacy (HL) is associated with short- and long-term health outcomes, and this is particularly relevant in Hispanics, who are disproportionally affected by lower HL. Hispanics have become the largest minority population in the United States. Also, Hispanics experience higher burdens of chronic diseases such as type 2 diabetes mellitus (T2DM) than non-Hispanic whites. Thus, effectively choosing culturally appropriate validated instruments that measure a marker found in health assessments should be a serious consideration. Using a systemized approach, we identified and reviewed 33 publications and found eight different HL and numeracy (separate or combined) instruments. We assessed the study designs and instrument structures to determine how HL was measured across these studies. We categorized the results into direct and indirect measurements of HL. The Test of Functional Health Literacy in Adults (TOFHLA) family of HL instruments was favored for direct measures of HL, while the Brief Health Literacy Screen (BHLS) instrument was favored for indirect measures. Despite identified trends in instruments used, more comprehensive measurement tools have been developed but not validated in Hispanic populations. In conclusion, further validation of more comprehensive HL instruments in adult Hispanic populations with T2DM could better assess HL levels and improve health promotion efforts

Multi-core symbolic bisimulation minimisation

Bisimulation minimisation alleviates the exponential growth of transition systems in model checking by computing the smallest system that has the same behavior as the original system according to some notion of equivalence. One popular strategy to compute a bisimulation minimisation is signature-based partition refinement. This can be performed symbolically using binary decision diagrams to allow models with larger state spaces to be minimised. This paper studies strong and branching symbolic bisimulation for labeled transition systems, continuous-time markov chains, and interactive markov chains. We introduce the notion of partition refinement with partial signatures. We extend the parallel BDD library Sylvan to parallelize the signature refinement algorithm, and develop a new parallel BDD algorithm to refine a partition, which conserves previous block numbers and uses a parallel data structure to store block assignments. We also present a specialized BDD algorithm for the computation of inert transitions. The experimental evaluation, based on benchmarks from the literature, demonstrates a speedup of up to 95x sequentially. In addition, we find parallel speedups of up to 17x due to parallelisation with 48 cores. Finally, we present the implementation of these algorithms as a versatile tool that can be customized for bisimulation minimisation in various contexts